Rate and risk factors for surgical site infection at a tertiary care facility in Peshawar, Pakistan

Surgical site infections [SSI] are among the most common complications in surgical patients and have serious consequences for outcomes and costs. This study aimed to determine the rates and risk factors affecting surgical site infections and their incidence at Surgical 'C' Unit, Khyber Teaching Hospital, Peshawar, Pakistan. The study was conducted to compare with rates obtained by large international multi-centre studies. A review of all general surgical interventions involving an incision, excluding anal procedures, performed between December 2008 and March 2009 [n=269] was undertaken. Various clinical parameters were recorded. Infection rates were calculated. Data were analysed using the Fisher's exact test. The overall SSI rate was 9.294%, 4.88% in clean cases [C], 8.39% in clean contaminated cases [CC], and 20.45% in contaminated or dirty cases [D]. There were significantly higher surgical site infection rates among patients with combined American Society of Anaesthesiologists scores II and III than those with ASA score I in clean contaminated [p=0.0007], and dirty cases [p=0.0212]. There were also significantly higher surgical site infection rates among patients with combined Co-morbidity Scale score 1-6 than those with no comorbid factors in clean contaminated [p=0.0002]. Surgical site infection rate was highest in gastrointestinal system surgeries. The Surgical site infections can be minimised by adopting international protocols for surveillance

Establishment of an efficient callus induction and plant regeneration system in Pakistani wheat (Triticum aestivum) cultivars

Four commercially grown wheat varieties of Pakistan, namely Inqilab-91, Chakwal-97, Tatara and Manthar were used for this investigation. For callus induction different concentrations of 2,4-Dichlorophenoxyaceticacid (2,4-D) along with 0.1 mg/L of Kinetin were evaluated. For regeneration initially different concentrations of Indole-3-Acetic Acid (IAA) and 6-BenzylAminoPurine (BAP) were tested. Best hormone combinations were further subjected to Kinetin and 6-ã-ã-dimethylallylaminopurine (2iP). For Inqilab-91, Chakwal-97 and Manthar, 3 mg/L of 2,4-D was found optimum, which induced 83.25 percent, 77.75 percent and 95.20 percent of embryogenic calli, respectively. Maximum callus induction (97.18 percent) was observed in Tatara when 2 mg/L of 2,4-D was used. As regard to regeneration, Inqilab-91, Chakwal-97 and Manthar showed maximum regeneration on media containing 0.1 mg/L IAA, 0.4 mg/L Kinetin and 0.5 mg/L 2iP, regenerating 87.25 percent, 81.75 percent and 68.75 percent respectively. For Tatara maximum regeneration of 12.25 percent was obtained on 0.1 mg/L IAA and 2 mg/L of BAP. Presently optimized regeneration method holds promise for facilitating the deployment of agronomical important trait through genetic transformation for the improvement of this important food crop.

Uptake of Tc-99m MIBI for assessment of cold thyroid nodule

Presence of nodule in the thyroid is a common problem throughout the world, incidence of which varies from region to region. This study was designed to appraise the diagnostic strategy to differentiate between malignant and benign lesions in solitary cold thyroid nodules using technetium-99m MIBI scintigraphy. Forty-nine patients were included in the study. All had cold nodule based on Tc-99m pertechnetate scan.Tc-99m MIBI thyroid scan and FNAC were performed in all the patients. Tc-99m MIBI thyroid scan was performed 20-40 min after intravenous injection of 185-370 MBq of Tc-99m MIBI. Uptake of MIBI in thyroid nodules was compared with that in the surrounding normal thyroid tissue and designation of YY, YN and NN were assigned to each nodule .YY means Intense uptake or uptake more than surrounding normal Thyroid tissue, YN means Uptake is equal or nearly equal to surrounding normal Thyroid tissue and NN means no uptake. FNAC revealed nodular goitre in 29 cases, follicular lesion in 8, cysts and hemorrhage in 10, pleomorph in 2. None of the cystic nodules were YY on MIBI scan, while the follicular lesions showed a variety of MIBI imaging patterns most frequently the YY pattern. None of the follicular lesion showed NN uptake on MIBI scan. In the diagnosis of follicular lesion the sensitivities of YY and YY+YN MIBI uptake patterns were 80% and 100% respectively. The YY+YN MIBI uptake patterns had a negative predictive value of 100% and positive predictive value of 36%, whereas a specificity of 54% was observed. After a cold nodule had been detected using Tc-99m pertechnetate, a second scan with YY or YN MIBI uptake increases the probability that this nodule would be suspicious for malignancy. Having no uptake of Tc-99m MIBI in such nodules very safely excludes the possibility of malignancy. Tc-99m MIBI scintigraphy is a useful method in the differential diagnosis of cold thyroid nodules. High MIBI uptake considerably increases the probability of malignancy and facilitates immediate surgical removal while NN or no uptake actually excludes it. We suggest MIBI scan as a routine diagnostic approach to cold thyroid nodules before fine-needle aspiration cytology

Use of plasmid DNA profiling in the investigation of human nosocomial infections

The need to control nosocomial [hospital - acquired] infections have spurred considerable efforts in the epidemiological mapping of the routes of transmission of these infection in the recent years. Plasmid DNA- profiling because of its simplicity and a high discriminatory power offers several advantages over the conventional epidemiological techniques [e.g.; sero-typing, bio - typing, antibiotic susceptibility profiling, phage- typing, etc]. This review describes the principles and technique of plasmid DNA profiling in the epidemiological investigations of nosocomial infections in human. Examples of the use of technique in the investigations of Staphylococcus aureus, S. epidermidis, other coagulase - negative Staphylococci, Ewingella Americana, Pseudomonas aeruginosa, serratia marcenscens, and Klebsiella infections have been reviewed. In view of the potential pitfalls of the plasmid DNA - profiling, the use of this epidemiological technique in conjunction in other bacterial - strains - typing techniques is recommended